- COVID-19 Sub-lineage BA.2.75 was first reported from India: WHO
- Currently, BA.5 and BA.4 are dominant variants in Europe and the US
- It’s likely that BA.2.75 may actually replace BA.5: Dr Sandeep Budhiraja
New Delhi: Since June 16, India has been seeing an uptick in daily COVID-19 cases; more than 10,000 cases are being reported every day. Amid this, a new sub-lineage that is being called the BA.2.75 has been reported from India and then from about 10 other countries. The World Health Organization (WHO) is tracking the emergence of the new sub-lineage. In a video posted on social media, WHO Chief Scientist Dr Soumya Swaminathan said, “There are still limited sequences available of the sub-variant to analyse, but this sub-variant seems to have a few mutations on the receptor-binding domain of the spike protein. So obviously, that’s a key part of the virus that attaches itself to the human receptor. So, we have to watch that. It’s still too early to know if this sub-variant has properties of additional immune evasion or indeed of being more clinically severe.”
Banega Swasth India team exclusively spoke to Dr Sandeep Budhiraja, Group Medical Director, Max Healthcare to get answers to all the questions around rising COVID-19 cases, new sub-lineage and the vaccines. Here are some excerpts from the conversation.
NDTV: How concerning is the recent uptick in cases in India?
Dr Sandeep Budhiraja: The rise in cases is not something to be concerned about. We need to understand the nature of Coronavirus and how it is going to behave. We have been seeing a lot of mutations happening over the last years. These mutations are a way for the virus to survive and the virus will keep mutating. The good thing is, in spite of these mutations, the disease severity has significantly gone down so we are now seeing a much smaller number of people requiring hospitalisations; extremely few people who will get very sick and deaths have become very uncommon. Most of the people are having a very mild disease even many times asymptomatic disease. The numbers are going up but you see this trend the world over. Each time the number goes up, it corresponds with a new sub-lineage being reported from different parts of the world. One needs to adopt caution and understand that the pandemic is not yet over. But there is no reason to be concerned.
NDTV: How worried should one be about the emergence of new sub-lineage BA.2.75 that has been reported in India and 10 other countries? How much do we know about it?
Dr Sandeep Budhiraja: India and 10 other countries have reported BA.2.75 but I am sure, it’s much more rampant than what is being reported. In Europe and the US, it’s BA.5 and to some extent BA.4 which is the predominant variant now. But the way things are going, it’s likely that BA.2.75 may actually replace BA.5. But the good news is that so far, all these variants have not been reported AS causing a severe illness. What is common between all these variants is that they are more transmissible and that’s the reason why they replace the previous variant. In January 2022, Omicron replaced Delta. As more mutations make the virus more transmissible, it replaces the previous variant.
The other common feature between all variants is that they have mutations in areas of receptor binding domain of the spike protein of the virus. This is that critical protein of the virus through which it attaches to the human cell. Any mutations in this part of the virus are very critical because this is what decides how invasive this virus will be into human cells and thereby it determines the severity. Secondly, it also determines whether the previous vaccination and infections have given you some immunity against this new mutation or sub-lineage or not. What we are seeing increasingly is that there is an immune escape phenomenon that means previous vaccinations and infections may not be giving you enough protection against this present mutant. That means you may get re-infected. For example, a person who has taken both the doses of the vaccine and a booster shot, is at the same risk of getting these infections as a person who is not vaccinated. Similarly, if a person has had a COVID-19 infection in the past and has developed protective antibodies, still he is at the risk of getting the infection. But does that mean vaccines are not effective? No, it’s not true. Vaccinations may not prevent you from getting an infection via a new mutant strain but clearly reduces the severity of your infection.
NDTV: What kind of strategy change should India adopt in light of these new variants? Like, India recently reduced the gap between the second dose and the booster dose.
Dr Sandeep Budhiraja: The reduction in the gap between the second dose and booster shot is a welcome decision. We do see that with any vaccination of COVID-19, whichever brand or type, the immunity is short-lasting and the antibodies begin to decline within a few months of vaccination. But, remember, decreasing antibodies level doesn’t mean that you no longer remain protected. There is something called immune memory in the body which gets triggered if you are re-infected. At the same time, yes, the level of antibodies goes down after about four to six months and that’s why a booster shot is given.
A lot of our population already has a natural infection. So, a combination of vaccination with the booster and natural disease gives you hybrid immunity and it’s the strongest type of immunity.
NDTV: Are vaccines still protecting us from all the variants?
Dr Sandeep Budhiraja: We take vaccines to protect ourselves from getting a severe disease. Present vaccines are not going to protect you from getting an infection with a new variant. This is called breakthrough infection. You will get infected, but vaccination will protect you from a severe disease.
Going forward, we need to look into next generation vaccines. Right now, the COVID vaccines world over, the ones which we know of, are specifically against the earliest variants of COVID – Wuhan, Alpha and Delta. The world is now trying to come up with newer vaccines and we should have those vaccines in near future, at least in the Western world where these vaccines will cater specifically to newer variants. Hopefully, now you will have vaccines against BA.2, BA.4 and BA.5.
The same happens with flu vaccine. Every year, at the start of winters or soon after monsoons, we take a flu vaccine. It’s an annual vaccine because every year, the composition of the vaccine changes depending upon what’s the most prominent flu virus in that part of the hemisphere. I think we are in for a similar situation as far as COVID vaccines are concerned. The world has that technology.
NDTV: How are we monitoring new variants and sub-lineages?
Dr Sandeep Budhiraja: It’s important for every country in the world to continue their genomic surveillance because mutants and sub-lineages can only be detected when surveillance is a continuous process. In India, we were able to detect the new lineage BA.2.75 because of this. If you are able to detect early, you can reduce the transmission because then you can restart the strategy of local containment rather than going into a national level containment.
Early detection of mutations will prevent the transmission of the disease to larger areas and also effectively help in getting new vaccines faster. It’s important to not only continue COVID testing but also, send a small percentage of samples for genome sequencing and release that data for public awareness.
NDTV: The COVID-19 pandemic is far from over. Learning from COVID-19, what steps India should take to protect itself from future pandemics?
Dr Sandeep Budhiraja: COVID-19 is not the last pandemic. Going forward, India needs to invest in manpower, infrastructure, resources and training. The allocation of the healthcare budget needs to be increased, and the new hospitals that are going to come should be ready to handle any pandemic in terms of infrastructure and manpower. Additionally, manpower should be trained and updated on infectious disease protocols. Regular training is important. We need to invest in all these things.
We also need to focus on public-private partnerships. We can’t put the onus completely on the government. Private healthcare, medical colleges, government hospitals, NGOs, and general practitioners who have their own clinics – all have to be one integrated force.
NDTV: Italy has started administering a second COVID booster dose to people over 60. Should India also follow the suit?
Dr Sandeep Budhiraja: I don’t think India is yet in a position or situation where we should start recommending a second booster. The priority right now is for people to complete two basic shots of vaccination and then take the first booster dose.
Remember, we need to continue to understand the dynamic of virus transmission. The virus is still there in the community and it is spreading from person to person. We will no longer ever be in a stage of going into lockdown, so, life hopefully that way will be back to what it used to be but, in a new way. When you are in crowded spaces, congested rooms, ensure you are wearing a mask, maintain social distancing and wash your hands frequently. If we follow these basic principles, we will slow down the virus transmission and over the months or years, as the immunity level of the entire population of the globe keeps getting better with repeated vaccinations and natural infections, overall, the pandemic will gradually slide into a phase of an endemic.
You can listen to the full Banega Swasth India podcast discussion by hitting the play button on the Spotify player embedded above.
NDTV – Dettol have been working towards a clean and healthy India since 2014 via the Banega Swachh India initiative, which is helmed by Campaign Ambassador Amitabh Bachchan. The campaign aims to highlight the inter-dependency of humans and the environment, and of humans on one another with the focus on One Health, One Planet, One Future – Leaving No One Behind. It stresses on the need to take care of, and consider, everyone’s health in India – especially vulnerable communities – the LGBTQ population, indigenous people, India’s different tribes, ethnic and linguistic minorities, people with disabilities, migrants, geographically remote populations, gender and sexual minorities. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign will continue to raise awareness on the same along with focussing on the importance of nutrition and healthcare for women and children, fight malnutrition, mental wellbeing, self care, science and health, adolescent health & gender awareness. Along with the health of people, the campaign has realised the need to also take care of the health of the eco-system. Our environment is fragile due to human activity, which is not only over-exploiting available resources, but also generating immense pollution as a result of using and extracting those resources. The imbalance has also led to immense biodiversity loss that has caused one of the biggest threats to human survival – climate change. It has now been described as a “code red for humanity.” The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene. Banega Swasth India will also be taking forward the dream of Swasth Bharat, the campaign feels that only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and the country can become a Swasth or healthy India.